For those of us entering our senior years, the news that dementia is now ranked as the number 1 cause of death in Australia may stoke the unsettling anxiety that this might happen to us. Dementia has always represented a substantial fear, perhaps because of the loss of control and personhood involved, and certainly most cases are associated with advancing age and more people are living longer. However, an unfortunate and inaccurate assumption of inevitability continues to prevail, which is being challenged by a wave of new research and initiatives, driven by decades of scientific research. A new, more hopeful attitude has emerged and the message is that there is capacity to control your future cognitive health, and look forward with confidence.
Research has identified a range of modifiable risk factors which may shift your risk against the background of age and the genes you inherit, the combination of which may effectively lead to an earlier or later onset of the condition. It has been estimated by the Lancet Commission into Dementia that there are at least 14 of these modifiable risk factors that, if they could be removed from the population, would lead to around 45% fewer cases of dementia. These factors are low educational attainment, hearing loss, visual loss, high LDL cholesterol, depression, traumatic brain injury, physical inactivity, diabetes, smoking, hypertension, obesity, excessive alcohol, social isolation and air pollution. The evidence base for these risk factors has recently been supported by a report from the World Health Organization (WHO), with the suggested addition of lifelong cognitive stimulation and maintaining a healthy, balanced diet as positive factors. It is important to note that you may have many of these risk factors and yet not develop dementia in your lifetime, and that you could have few or none of these factors and still develop dementia. This exemplifies that ageing is the most substantial risk factor, and that genetics also plays a role.
The Wicking Dementia Research and Education Centre has undertaken a large-scale study centred on assisting people to reduce risk and build resilience to conditions such as dementia. The Island Study Linking Ageing and Neurodegenerative Disease (ISLAND) commenced in 2019 and has a focus on helping participants in building self-efficacy in managing dementia risk. ISLAND has involved many thousands of Tasmanians over the age of 50, and a recent analysis of 6 years of data has shown that it has been effective in reducing the health factors linked to dementia. Along the way, ISLAND participants have been very generous in contributing to a range of research projects such as blood and digital biomarkers of neurodegeneration, identifying sleep conditions that are associated with greater risk of dementia and Parkinson’s disease, building the resilience of communities to potential disasters and examining the benefits of education for older adults. This unique Tasmanian program has also been recently recognised as the best existing approach to population-level interventions for dementia prevention in a publication in Lancet Healthy Longevity.
While ISLAND has had a focus on individual in terms of building knowledge and self-efficacy in managing dementia risk, it is increasingly being recognised that the broader community has a role here as well. There are activities and policies we can pursue at a local through to organisational and government level that may assist brain health. These may be about promoting physical activity, healthy eating and social connectedness, as well as awareness of the value of education for brain health, providing support for detecting hearing and visual loss, and the policies that will minimise the risk of head injury.
Exciting areas of research from the Wicking Centre have also been focussed on identifying ‘biomarkers’ to assist in diagnosis. This has included the analysis of blood samples as well as ‘digital’ biomarkers, the latter which use AI to analyse subtle changes in movement. It is now recognised that conditions such as Alzheimer’s disease begin many years before symptoms may be obvious and so a focus of using very sensitive biomarkers for identifying the early stages may also provide the best opportunity for medical intervention.
Clearly, dementia represents a significant health, social and economic challenge across Australia, where we are struggling to develop the best approaches and models of care to support such a large number of people impacted by the condition. There are very few options for treatment and it can also be a very difficult condition to diagnose. The Commonwealth Government has identified dementia as a health priority and a recent National Dementia Action Plan has been established to guide actions across Australian, state and territory governments to improve services and systems for dementia. There have been a number of local developments to support people with dementia, including the establishment of a specialist dementia care program unit and residential facilities specifically designed for people with dementia, new dementia training programs in the hospital sector and community-based ‘dementia-friendly’ initiatives. The Wicking Centre also continues its work in a broad set of dementia education opportunities, including a very successful recent program on supporting quality dementia respite across the country, as well as a clinic that is providing access to a diagnostic service as well as the latest clinical trials.
If you may be interested in learning more about dementia prevention and brain health, the free online ‘Preventing Dementia Massive Open Online Course’ and other courses are available at mooc2.utas.edu.au. If you may wish to review your own health risk factors against Lancet and WHO guidelines, online tools are available at leytonworks.com.au.